Monday, 31 March 2014

Ellipses matter: North & South

On my hopelessly out-of-date University homepage, I have a little .js that puts a random-draw fun quote at the bottom of the page. A few years ago, the usual sorts got real angry about some fast food joint offering a bacon sundae. So I added this:*

Death
to all food and wine rules. Down with the health establishment. Bacon is the
ultimate expression of freedom... Bacon is sex in a skillet... It's the
ultimate aphrodisiac for all living things. Except pigs, of course. - Dan Philips.

It's fun. It's as over-the-top pro-bacon as you can get, which I figured was about right. It's obviously tongue-in-cheek, if you read the whole thing.

After Donna Chisholm interviewed me for North & South Magazine about my work with the Brewers Association, wondering whether it was evil, corrupt, or both that the University might countenance industry support of research, she included this:

He [Crampton] says those findings could be unfavourable to the industry, but a quote he referenced on his internet homepage - "Death to all food and wine rules. Down with the health establishment..." - seems to point to his own stance.

A fun obviously over-the-top quote on the merits of bacon and the good life instead looked like part of the manifesto of a jihadist. And the quote was primarily about bacon, not alcohol! There are 28 quotes that come up on random draw. I wonder which public health aficionado sat there hitting F5 over and over to see what would come up. I doubt Chisholm did it and rather expect that one of her public health interviewees passed it along to her. I wonder whether he or she sent it to Chisholm in full, or just as except. As the excerpting substantially changes the tone and meaning of the quote, I would be surprised if a journalist of her calibre had done the excerpting: it is just a little bit misleading.

Chisholm also cites my December disclosures post as a blog post "justifying his contract." I wrote it primarily as disclosure, not apologia. I think disclosure is important.

But Chisholm seems to see alcohol conspiracies. She writes:

For a time in the 1990s, Auckland epidemiologist Rod Jackson was at the top of the invitation lists to speak at international meetings on alcohol and disease. He had written around a dozen papers, based on evidence from his own and other studies, saying that light-to-moderate alcohol consumption reduced the risk of heart disease.

In the early 2000s, however, new papers emerged which proved that the design of these trials was flawed, and in a paper in the Lancet in 2005, Jackson admitted he'd got it wrong: any coronary protection from drinking was unlikely to outweigh its known harms.

Almost overnight, the invitations dried up. In the nine years since, he's had just one. Suddenly, Jackson asked himself, were all those conferences as independent as he thought they were at the time? "I'd believed I had been careful. It was scary."

We might note that the Jackson 2005 Lancet piece wasn't an article, or at least not as we normally understand such things. It was a two-page note published in their "Comment" section where Jackson and coauthors worried that uncontrolled confounding might have contaminated results: the protective effect among lighter drinkers could be an artefact of former heavy drinkers' inclusion among non-drinkers, while protective effects among heavy drinkers could be underestimated.

It's definitely something worth worrying about, and indeed had been noted as early as 1988 by Shaper et al. And so, Di Castelnuovo and Donati's 2006 metastudy carefully separated studies that had excluded former drinkers from the "abstainer" category from those studies that hadn't been so careful. The protective effect among light drinkers on total mortality risk was a bit smaller in the careful studies, but was hardly non-existent. Further, Rimm and Moats 2007 directly assessed whether uncontrolled confounding either through sick-quitters or through other healthy behaviours could be responsible for measured cardioprotective effects among light-to-moderate drinkers. They find strong evidence that alcohol provides a substantial cardioprotective effect that is not due to residual confounding.

Jackson's question was worth asking. But it's been entirely answered since then.

So, is it then more likely that any decline in conference invitations is due to some big conspiracy at these conferences to blackball him, or to that Jackson seems to have latched onto one dismissal of a line of research that has moved on substantially since his op-ed critique? I think about parallels in economics, like the small part of the Austrian movement** that hasn't figured out that the mainstream has largely incorporated Hayekian insights about information and who want to keep fighting a version of economics that existed circa 1970. They don't get much play at mainstream conferences either, and I don't think it's because of any conspiracy.

I'll copy below what I'd sent Donna by email after our phone conversation.

If it helps, here are some more
clearly phrased thoughts on the things we discussed this morning.

“I suggested the funding
arrangement to the Brewers because it seemed a useful way to let me continue
doing work I enjoy on alcohol policy despite a constrained budgetary
environment at the University. External funding of 20% of my position was also
one way I saw that I could help while things were tight. Finally, the
University has been wanting more connections with industry and other external
stakeholders. I’m really glad that the University and the Brewers Association
were able to agree on a set of terms that let me continue my work with full
academic freedom.”

“While I agree that the Brewers
would have been unlikely to have helped fund my work if I had spent the last
decade loudly advocating the prohibition of alcohol, I also doubt that the
Brewers would have been interested in helping me if I lacked academic rigour.”

“I think industry and academia
need to come together more often. I gave a talk for Strategic Link, an
agriculture industry group, a couple of years ago. The speaker before me spent
a lot of time complaining that academics don’t focus on the kinds of research
he thought would be valuable for his industry. The audience, including some
prominent ag industry CEOs, seemed very surprised when I suggested that they
could fund Chairs or otherwise part-fund academic positions, with a condition
of funding being that the academic do some work in the area; they hadn’t
thought it was even possible. There hasn’t been much tradition of private
funding in New Zealand. In North America, industry and philanthropically-funded
Chairs are very common; universities typically also enjoy very strong financial
support from alumni. As public funding becomes more constrained, I think New
Zealand will have to do more on both fronts.”

“The public health sector and
economists focus on different things. Researchers in public health care a lot
about reducing the harms that come from substance use, whether it be alcohol,
tobacco, or soda. And, in a world where policies addressing those kinds of
concerns were costless, we’d be on the same page. Harms are bad. Unfortunately,
a lot of the policies targeting the harms of harmful consumption also have
substantial effects on those who consume those products harmlessly. Economists
want to weigh the benefits of policies addressing harmful consumption against
the costs imposed on those who aren’t really doing anybody any harm. The two
approaches then tend to lead to pretty different recommendations. Public health
advocates lean heavily towards price-based measures for reducing consumption.
Economists worry that prices have rather less effect on the heaviest harmful drinkers
than they have on moderate and light drinkers. We then need to balance the
harms avoided against the harms imposed. It isn’t enough just to show that
heavy drinkers show some responsiveness to prices – we have to weigh that
against the losses we impose on moderate drinkers.”

“The Law Commission’s review of
the evidence around alcohol policy was, in my view, inadequate. In our
submission to the Law Commission, Matt Burgess and I pointed out that the Law
Commission entirely misread the evidence around drinkers’ price responsiveness
and were too quick to draw causal inferences from correlations between alcohol
use and social ills.” [Please note that our submission is available here and that we revised the NZ social cost figure upwards in our 2011 report.]

I later followed up with this, after she'd sent along some of the particular critiques mentioned about industry funding in academia:

It might be worth your looking at North American precedents
though. I modelled my disclosure statement on that of Andrew Leach, an
economist at the University of Alberta who holds the Enbridge Professorship.
He’s an energy economist; Enbridge is a big energy company.

When I was a graduate student, I was taught by Professors
holding a number of externally funded chairs, some philanthropically supported,
others with industry support. My dissertation advisor, Tyler Cowen, held (and
still holds) the Holbert Harris Chair in Economics; that one was funded by a
charitable trust established in memory of businessman Holbert Harris. BB&T
Bank funds Chairs in Economics at a pretty large number of Universities; I’ve
not heard that this has made the holders and more or less supportive of banking
regulation. It definitely seems less common in New Zealand. I could speculate about
the reasons for that, but it would really only be speculation.

With any kind of industry support, there will be some group that
sees it as the end of the world. Environmental activists would reckon
energy-industry funding to be contrary to the public good and the wellbeing of
the population, because they define both of those things in ways particular to
themselves. Certain sectors would view bank funding as unethical because they
view banks as unethical; the Bank of New Zealand has funded Chairs in Finance.
Funding from the food industry would be opposed by obesity activists. It’s hard
to think of any potential funding source that wouldn’t be viewed as unethical
by at least some people. For many in the activist sector, the only legitimate
source of research funding is the taxpayer, routed through the Ministries.
While that’s certainly one view of ethics, it isn’t the only one, and it isn’t
mine. One could just as easily say that Ministry of Health funding fosters
dependency and builds a reluctance for criticism of the Ministry of Health and
for questioning of government policy goals. I think it’s important that
academia benefit from a diversity of funding sources. In all of this, I speak
only for myself and do not purport to represent the University’s views.

* At least that's when I think I added it. It could have been earlier, during some other anti-bacon hysteria.